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| 1 | Body-mass index correlates with severity and mortality in acute pancreatitis: A meta-analysis显示文摘BACKGROUND Obesity rates have increased sharply in recent decades. As there is a growing number of cases in which acute pancreatitis(AP) is accompanied by obesity, we found it clinically relevant to investigate how body-mass index(BMI) affects the outcome of the disease.AIM To quantify the association between subgroups of BMI and the severity and mortality of AP.METHODS A meta-analysis was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis(PRISMA) Protocols. Three databases(PubMed, EMBASE and the Cochrane Library) were searched for articles containing data on BMI, disease severity and mortality rate for AP. Englishlanguage studies from inception to 19 June 2017 were checked against our predetermined eligibility criteria. The included articles reported all AP cases with no restriction on the etiology of the disease. Only studies that classified AP cases according to the Atlanta Criteria were involved in the severity analyses. Odds ratios(OR) and mean differences(MD) were pooled using the random effects model with the DerSimonian-Laird estimation and displayed on forest plots. The meta-analysis was registered in PROSPERO under number CRD42017077890.RESULTS A total of 19 articles were included in our meta-analysis containing data on 9997 patients. As regards severity, a subgroup analysis showed a direct association between AP severity and BMI. BMI < 18.5 had no significant effect on severity;however, BMI > 25 had an almost three-fold increased risk for severe AP in comparison to normal BMI(OR = 2.87, 95%CI: 1.90-4.35, P < 0.001). Importantly,the mean BMI of patients with severe AP is higher than that of the non-severe group(MD = 1.79, 95%CI: 0.89-2.70, P < 0.001). As regards mortality, death rates among AP patients are the highest in the underweight and obese subgroups. A BMI < 18.5 carries an almost two-fold increase in risk of mortality compared to normal BMI(OR = 1.82, 95%CI: 1.32-2.50, P < 0.001). However, the chance of mortality is almost equal in the normal BMI and BMI 25-30 subgroups. A BMI >30 results in a three times higher risk of mortality in comparison to a BMI < 30(OR = 2.89, 95%CI: 1.10-7.36, P = 0.026).CONCLUSION Our findings confirm that a BMI above 25 increases the risk of severe AP, while a BMI > 30 raises the risk of mortality. A BMI < 18.5 carries an almost two times higher risk of mortality in AP. | Dalma Dobszai Péter Mátrai Zoltan Gyongyi Dezso Csupor Judit Bajor Balint Eross Alexandra Mikó Lajos Szakó Agnes Meczker Roland Hágendorn Katalin Márta Andrea Szentesi Péter Hegyi on behalf of the Hungarian Pancreatic Study Group | 2019 | World Journal of Gastroenterology2019，25，6： | 11 |
| 2 | Intralesional steroid is beneficial in benign refractory esophageal strictures:A meta-analysis显示文摘AIM To analyze the effect of intralesional steroid injections in addition to endoscopic dilation of benign refractory esophageal strictures.METHODS A comprehensive search was performed in three databases from inception to 10 April 2017 to identify trials, comparing the efficacy of endoscopic dilation to dilation combined with intralesional steroid injections. Following the data extraction, meta-analytical calculations were performed on measures of outcome by the randomeffects method of Der Simonian and Laird. Heterogeneity of the studies was tested by Cochrane's Q and I^2 statistics. Risk of quality and bias was assessed by the Newcastle Ottawa Scale and JADAD assessment tools.RESULTS Eleven articles were identified suitable for analyses, involving 343 patients, 235 cases and 229 controls in total. Four studies used crossover design with 121 subjects enrolled. The periodic dilation index(PDI) was comparable in 4 studies, where the pooled result showed a significant improvement of PDI in the steroid group(MD:-1.12 dilation/month, 95% CI:-1.99 to -0.25 P = 0.012; I^2 = 74.4%). The total number of repeat dilations(TNRD) was comparable in 5 studies and showed a non-significant decrease(MD:-1.17, 95%CI:-0.24-0.05, P = 0.057; I^2 = 0), while the dysphagia score(DS) was comparable in 5 studies and did not improve(SMD: 0.35, 95%CI:-0.38, 1.08, P = 0.351; I^2 = 83.98%) after intralesional steroid injection.CONCLUSION Intralesional steroid injection increases the time between endoscopic dilations of benign refractory esophageal strictures. However, its potential role needs further research. | László Szapáry Benedek Tinusz Nelli Farkas Katalin Márta Lajos Szakó Agnes Meczker Roland Hágendorn Judit Bajor Aron Vincze Zoltan Gyongyi Alexandra Mikó Dezso Csupor Péter Hegyi Balint Eross | 2018 | World Journal of Gastroenterology2018，24，21： | 7 |
| 3 | Network meta-analysis of randomized controlled trials on esophagectomies in esophageal cancer:The superiority of minimally invasive surgery显示文摘BACKGROUND Previous meta-analyses,with many limitations,have described the beneficial nature of minimal invasive procedures.AIM To compare all modalities of esophagectomies to each other from the results of randomized controlled trials(RCTs)in a network meta-analysis(NMA).METHODS We conducted a systematic search of the MEDLINE,EMBASE,Reference Citation Analysis(https://www.referencecitationanalysis.com/)and CENTRAL databases to identify RCTs according to the following population,intervention,control,outcome(commonly known as PICO):P:Patients with resectable esophageal cancer;I/C:Transthoracic,transhiatal,minimally invasive(thoracolaparoscopic),hybrid,and robot-assisted esophagectomy;O:Survival,total adverse events,adverse events in subgroups,length of hospital stay,and blood loss.We used the Bayesian approach and the random effects model.We presented the geometry of the network,results with probabilistic statements,estimated intervention effects and their 95% confidence interval(CI),and the surface under the cumulative ranking curve to rank the interventions.RESULTS We included 11 studies in our analysis.We found a significant difference in postoperative pulmonary infection,which favored the minimally invasive intervention compared to transthoracic surgery(risk ratio 0.49;95%CI:0.23 to 0.99).The operation time was significantly shorter for the transhiatal approach compared to transthoracic surgery(mean difference-85 min;95%CI:-150 to-29),hybrid intervention(mean difference-98 min;95%CI:-190 to-9.4),minimally invasive technique(mean difference-130 min;95%CI:-210 to-50),and robot-assisted esophagectomy(mean difference-150 min;95%CI:-240 to-53).Other comparisons did not yield significant differences.CONCLUSION Based on our results,the implication of minimally invasive esophagectomy should be favored. | Lajos Szakó Dávid Németh Nelli Farkas Szabolcs Kiss Réka Zsuzsa Domotor Marie Anne Engh Péter Hegyi Balint Eross András Papp | 2022 | World Journal of Gastroenterology2022，28，30： | 1 |
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